Alberta Health has plans to boost the number of surgeries performed in the province in 2024 and is counting on a record number of procedures being contracted to private, for-profit facilities to meet its target.
Alberta’s 2024 budget includes $305 million to support approximately 310,000 operating room procedures. Alberta Health estimates between 60,000 and 65,000 of these publicly funded procedures will be performed by privately-owned chartered surgical facilities (CSFs), an increase of 27–37 per cent from the 47,400 surgeries performed in CSFs in 2022–23, the last full year for which publicly reported statistics are available.
How much of the $305 million budget will go directly to private facilities is unclear. Andrea Smith, press secretary for the Minister of Health, said in an email that the budgets for surgical initiatives vary on a number of factors, both in hospitals and at CSFs.
Andrew Longhurst, a health policy researcher at Simon Fraser University, has studied the impacts of the increased use for-profit surgical facilities on surgical capacity and wait times in Alberta, and said he is concerned the projected expansion of CSF patient volume will further constrain existing staffing resources.
“As you move that significant amount of volume into the chartered surgical facilities, you're going to be causing shortages around OR nursing and anaesthesia services. These are areas where we're in short supply in public hospitals,” Longhurst said.
“There's no question in my mind that it's going to have a really significant and detrimental effect on the ability of public hospitals to maintain their volumes. And it's going to make it pretty much impossible to increase their volumes in the way that they need to.”
In 2020, Alberta committed $400 million to outsourcing surgeries to private clinics through the Alberta Surgical Initiative (ASI), stating that this would free up space in existing hospitals and improve waiting times for all Albertans.
Longhurst’s research analyzed data from the first three years of the ASI, and found that rather than improving access, resources were diverted from public hospitals, increasing wait times and reducing overall surgical capacity.
According to data from Alberta Health Services, the number of hip replacements performed within the national benchmark wait time in Alberta has fallen from 65.5 per cent in 2019-20 to 42.9 per cent in 2022-23. Results for knee replacements declined from 61.5 per cent in 2019-20 to 32.1 per cent in 2022-23. The wait times for cataract surgeries, however, improved by 20 per cent during this same period.
The total provincial surgical volume decreased by 6 per cent between 2018-2019 and 2021-2022, according to Longhurst's research.
Longhurst said Alberta experienced this reduced surgical capacity because as more public dollars flow to encourage growth in the for-profit sector, there is also a movement of staff to CSFs. “You're not doubling or expanding the staffing resources that you have, you’re simply shifting them.”
Smith said the increase in wait times was due to the pandemic, which created a backlog of patients for surgeries requiring an overnight stay, such as hip and knee replacements.
The province remains committed to contacting more surgeries to CSFs and increasing the number of surgeries performed in public operating rooms, Smith said.
“CSFs have increased capacity to allow more surgeries to happen overall. Thousands of Albertans are now getting their publicly funded surgeries at these chartered surgical facilities which is freeing up operating rooms in hospitals to handle more complex surgeries,” she said.
“The number of surgeries performed in Alberta is increasing year-over-year. As of January 2024, the total number of surgeries performed at AHS sites and CSFs in 2023-24 was at 253,215.”
Smith also said wait times have been improved for both hip and knee replacements because of CSFs.
The total number of surgeries performed in 2018-19, before the pandemic, was 285,945. Data from 2022-23 shows that surgical volumes in Alberta are starting to recover from the pandemic, with a total of 292,500 procedures being performed in public and private facilities.
In recent years, the scope of surgeries able to be performed at CSFs has expanded to include more orthopaedic procedures and general surgeries, though they are generally contracted to perform less complex procedures involving healthier, low acuity patients.
Because this represents a limited pool of potential patients, Longhurst said he thinks the government will soon run into issues of having enough suitable patients to meet their goal of having 30 per cent of surgeries performed in private facilities.
"I think there's no question that this is ideologically motivated," he said.
“Unless they're moving towards these for-profit facilities becoming full-blown acute care facilities – which may be their vision, and I think there's reason enough to believe that that is their vision – I think they're going to run into the challenge of actually making good on the 60–65,000 cases that they want to be performed annually in these for-profit facilities.”
Longhurst said the weight of the research evidence shows the jurisdictions best able to improve surgical wait times have been those that make sustained funding commitments to public sector capacity "where the infrastructure already exists.
"There's a huge cost, both in dollar terms and in operational and administrative complexity, in building up a parallel for-profit delivery sector. And that's what we're seeing in Alberta. And it is coming at the expense of all of the time and resources within AHS and Alberta Health to be able to basically build a for-profit sector that can do what public hospitals can already do."
